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目的探讨矮小症患儿的病因及胰岛素样生长因子(IGF)-1与生长激素(growth hormone,GH)水平之间的关系,建立基于IGF-1水平的简易GH缺乏(GHD)诊断预测模型。方法矮小症住院患儿1 496例,采用胰岛素低血糖法和精氨酸法测定GH分泌状态,根据体格检查及实验室检查分析病因;Logistic逐步多元回归模型建立基于IGF-1的GHD诊断预测模型。结果 GHD659例(44.05%),特发性矮小504例(33.69%),家族性矮小165例(11.03%),体质性青春期发育延迟35例(2.33%),余为甲状腺功能减低症、宫内发育迟缓、Turner综合征、多种垂体激素缺乏症等引起的矮小症。比较GHD与非GHD两组患儿潜在的影响因素,体质量、BMI、身高-SDS、ALT/AST/AKP、TG/Tch、IGF-1、IGFBP-3等的差异有统计学意义(P<0.05)。设GHD的概率为P,经Logistic逐步多元回归模型拟合如下:LN[P/(1-P)]=-2.0193+0.0683×年龄+0.1439×BMI+0.021×ALT-0.0021×IGF-1-0.1526×IGFBP-3。结论内分泌疾病是矮小症最多见的病因,但GH激发试验的水平与多种体格和生化指标有关,因此GHD诊断需要综合考虑;基于IGF-1拟合的简易模型对GHD诊断有较准确的预测价值,可用于门诊筛查。
Objective To investigate the etiology and the relationship between growth hormone (IGF-1) and growth hormone (GH) in children with short stature and to establish a predictive model of simple GH deficiency (GHD) based on IGF-1 level. Methods A total of 1 496 hospitalized patients with short stature were enrolled in this study. The GH secretion status was determined by insulin hypoglycemia and arginine method, and the etiology was analyzed by physical examination and laboratory tests. Logistic regression model was used to establish GHD diagnosis and prediction model . Results There were 659 cases of GHD (44.05%), 504 cases of idiopathic short stature (33.69%), 165 cases of familial short stature (11.03%) and 35 cases (2.33%) of retardation of constitutional puberty. The rest were hypothyroidism, intrauterine Stunner, Turner syndrome, a variety of pituitary hormone deficiency caused by short stature. The differences of body mass, BMI, height-SDS, ALT / AST / AKP, TG / Tch, IGF-1 and IGFBP-3 between the two groups were statistically significant (P < 0.05). The probability of setting GHD was P, and fitted by Logistic stepwise multiple regression model as follows: LN [P / (1-P)] = -2.0193 + 0.0683 × age + 0.1439 × BMI + 0.021 × ALT- 0.0021 × IGF- 1-0.1526 × IGFBP-3. Conclusions Endocrine disease is the most common cause of short stature. However, the level of GH challenge test is related to various physical and biochemical indexes. Therefore, the diagnosis of GHD needs to be considered comprehensively. The simple model based on IGF-1 fitting has a more accurate prediction of GHD diagnosis Value, can be used for outpatient screening.